Key Takeaways

• Medicare is not a set-it-and-forget-it program. Reviewing your coverage annually ensures you stay protected and avoid unexpected costs.

• From plan changes to evolving health needs, keeping an eye on Medicare every year helps you get the care you expect and deserve.

Why Trust in Medicare Still Requires Oversight

Medicare is one of the most trusted programs in the United States, serving millions of older adults and individuals with disabilities. In 2025, it continues to provide essential health coverage through its various parts: A, B, C, and D. However, just because Medicare is a longstanding federal program doesn’t mean it runs on autopilot for your personal needs.

Each year, changes occur—some driven by policy updates, others by your own evolving health situation. If you rely on Medicare and assume that last year’s plan will work this year too, you might be setting yourself up for higher costs or coverage gaps.

Medicare Changes Every Year—And They Matter

Even small updates to your Medicare plan can result in significant changes to your out-of-pocket costs or benefits. These updates often take effect on January 1 and are communicated through the Annual Notice of Change (ANOC) letter you receive in the fall.

Some key aspects that change every year include:

• Premiums and deductibles: In 2025, the standard Part B premium is $185, and the deductible is $257. Part A and Part D also see annual updates.

• Prescription drug coverage: With the 2025 Part D cap now set at $2,000, how and when you reach this threshold can differ by plan.

• Provider networks: Your doctor or preferred pharmacy may no longer be in-network under your current plan.

• Covered services and co-pays: Some plans adjust cost-sharing structures, impacting what you pay for services like specialist visits, emergency care, or diagnostic testing.

Annual Enrollment Is Your Window to Act

The Medicare Open Enrollment Period runs from October 15 to December 7 each year. During this window, you can:

• Switch from Original Medicare to a Medicare Advantage plan (Part C), or vice versa.

• Change from one Medicare Advantage plan to another.

• Join, drop, or change your Part D prescription drug plan.

If you don’t take action during this period, you’re generally locked into your current plan until the next year unless you qualify for a Special Enrollment Period due to specific life changes.

How Your Health Needs Influence Your Plan

Your health isn’t static, and your Medicare coverage shouldn’t be either. Every year, you should take stock of the following:

• New diagnoses or chronic conditions that require different specialists or treatments.

• New medications that may or may not be on your current plan’s formulary.

• Hospital or outpatient care usage that affects whether you need broader coverage.

• Changes in income, which could affect what you pay for Medicare premiums (especially if you are subject to IRMAA adjustments).

Staying with a plan that no longer matches your health needs could cost you more, both financially and medically.

Don’t Assume Part D Will Always Cover Your Drugs

One of the most common Medicare mistakes is assuming that a Part D plan will cover the same drugs every year. In 2025, prescription drug plans must adhere to the new $2,000 annual cap, but how each plan gets there—formulary updates, tier changes, and preferred pharmacy networks—can shift from year to year.

Each fall, review the Evidence of Coverage and ANOC documents to see:

• If your medications are still covered

• If they’ve been moved to a higher cost tier

• If your pharmacy is still in-network

Failing to review these details can result in unexpected costs in January.

Medicare Advantage Plans Can Change the Most

Medicare Advantage plans (Part C) are offered by private insurance companies approved by Medicare. While many beneficiaries find them convenient, these plans can change significantly year to year:

• Out-of-pocket maximums: The 2025 in-network limit is $9,350. Changes in your plan’s MOOP (maximum out-of-pocket) can greatly affect your total costs.

• Supplemental benefits: Popular extras like dental, vision, and hearing may be added, removed, or altered.

• Referrals and authorizations: Plan rules around specialist visits and prior authorizations may evolve.

The bottom line: Even if your plan has worked well so far, it’s critical to read the annual updates and reassess each fall.

Medicare Cost-Sharing in 2025

Understanding what you’re responsible for paying can help you determine whether your current plan still works for you.

Part A (Hospital Insurance):

• Deductible: $1,676 per benefit period

• Coinsurance: $419/day for days 61–90; $838/day for lifetime reserve days

• Skilled nursing facility coinsurance: $209.50/day for days 21–100

Part B (Medical Insurance):

• Monthly premium: $185 (standard)

• Annual deductible: $257

• Coinsurance: Typically 20% after deductible for most services

Part D (Prescription Drugs):

• Deductible: Up to $590

• Out-of-pocket cap: $2,000 for the year

Review your total cost exposure, not just premiums. Plans with low premiums might include high deductibles, copayments, or coinsurance.

What to Look For in Your Annual Medicare Review

Every fall, you should review the following elements of your plan:

• Premiums: What you’ll pay monthly, and whether IRMAA applies

• Deductibles and copayments: Are they manageable?

• Provider access: Is your doctor still in-network?

• Drug coverage: Are all your prescriptions still covered?

• Pharmacy access: Will your local pharmacy be considered preferred?

• Supplemental benefits: Are extras like dental or vision care still included?

You don’t need to do this alone—assistance from a licensed agent can help ensure you make informed choices.

Medicare Scenarios That Trigger a Review

Even outside the fall enrollment window, certain life changes qualify you for a Special Enrollment Period. These include:

• Moving to a new address that isn’t in your plan’s service area

• Losing other health coverage, such as employer-based insurance

• Becoming eligible for Medicaid or Extra Help

• Moving into or out of a skilled nursing facility

In such cases, you can make changes to your Medicare plan outside of the typical October–December enrollment period.

What Happens If You Don’t Review Your Plan

Staying with the same plan without reviewing it can result in:

• Higher out-of-pocket costs due to changes in premiums or cost-sharing

• Lack of coverage for medications no longer on the formulary

• Surprise bills from out-of-network providers

• Missed opportunities for better benefits elsewhere

A yearly review helps avoid these issues and puts you in control of your healthcare.

Staying Proactive Means Staying Protected

You trust Medicare to be there when you need it. But the smart approach is to treat that trust as a partnership. Medicare provides the structure, but you need to make the annual effort to ensure it still fits your life.

If the system changes—and it does every year—your coverage needs to keep up.

To make the most of Medicare in 2025 and beyond, schedule an annual review before the October 15 to December 7 Open Enrollment period begins. Look at your health, budget, and plan performance from the past year. And when in doubt, get professional guidance.

Ready to Take Charge of Your Coverage?

Staying ahead of Medicare changes helps you make smarter choices, reduce unexpected costs, and feel confident that your health needs are met. If you haven’t reviewed your plan yet this year, now is the time.

To get help reviewing your current Medicare options or comparing available choices, speak with a licensed agent listed on this website. A quick conversation can give you peace of mind—and potentially save you money.